病理生理心血管系统疾病
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➢ In large amounts it acts as a vasoconstrictor. 3-4 drinks is bad!
Risk Factors
Non modifiable ➢ Age ➢ Sex ➢ Family history
(Genetic)
Potentially modifiable ➢ Hyperlipidemia ➢ Hypertension ➢ Smoking ➢ Diabetes ➢ Life style, diet, and exercise
Atherosclerosis
动脉粥样硬化
Introduction
➢ Disease of the large and medium-sized arteries.
➢ Fat deposits, hardening and destruction. ➢ Major cause of IHD, MI and Stroke. ➢ Major primary cause of death in most
➢ Hypercholesterolemia – risk
高胆固醇血症
➢ Hypertriglyceridemia - less significant
高甘油三酯血症
Types of Cholesterol
➢ Chylomicrons (CM) ➢ Very low density lipoproteins (VLDL) ➢ Low density Lipoprotein (LDL) ➢ High density Lipoprotein (HDL)
more than five fold greater risk than those with blood pressures of 140/90 mmHg or lower
Cigarette Smoking
➢ Smoking aggravates the injury of endothelial cells.
HDL
➢ Tissues and cells
the liver
➢ It does not have the tendency to clog arteries.
Good cholesterol !
Hypertension
➢ A major risk factor at all ages ➢ Blood pressure exceeds 160/95mmHg
Dissecting aneurysms Rupture
Coronary Atherosclerosis
冠状动脉粥样硬化
狭窄程度
➢ I级 ➢ II级 ➢ III级 ➢ IV级
≦25% 26%-50% 51%-75% >75%
Coronary AS
Coronary Heart Disease （CHD）
countries.
artery Arteriosclerosis 动脉硬化
atheroma
arteriole
Atherosclerosis Mőnckeberg Ateriolosclerosis
Large BV Medial Sclerosis
Small BV
Intima
Medial BV
Full Thickness
➢ Unstabile angina 不稳定性心绞痛
✓ nonocclusive thrombus, occurs at rest
➢ Prinzmetal angina 变异性心绞痛
✓ coronary artery vasospasm ✓ often occurring at rest
Myocardial infarction, MI
Major Disorders of CVS
➢ Atherosclerosis ➢ Ischemic Heart Disease (IHD) ➢ Hypertension ➢ Rheumatic Heart Disease (RHD) ➢ Infective Endocarditis ➢ Valvular Heart Disease (VHD)
Nucleus
LAL
ApoA1
ABCA1
Cholesterol
HDL
Efflux
ABCG1
FC
Transcription Factors
Oxidation
FA
nCEH ATGL
HSL
TGCE
ER ACAT
Cholesterol Crystal
ADRP Perilipin
LD Proteins
Cytoplasmic LD
Changeable Risk Factors
➢ Hyperlipidemia ➢ Hypertension ➢ Cigarette Smoking ➢ Diabetes Mellitus ➢ Obesity ➢ Physical Inactivity ➢ Alcohol Intake
Hyperlipidemia 高脂血症
Monocytes Adhesion & Diapedesis
Modified LDL Intima
SRs
LDLR
Macrophage
Lumen Endothelial Cells
Cytoplasmic LD
Foam Cell
Modified LDL
CD36
SR-A Endosome
Late Endosome
Atheroma 粥瘤
Fibrous Cap Necrotic center Cholesterol Cry. Macrophages
Complications - development
Rupture Hemorrhage
Erosion, ulceration
Thrombosis
Ischemia
LDL
➢ The liver
tissues and cells
➢ A major component of the tissues and cells
➢ Atherosclerotic plaque that clogs arteries ➢ Increases risk of CHD
Bad cholesterol !
冠状动脉性心脏病 （冠状动脉粥样硬化性心脏病）
Coronary Heart Disease , CHD
➢ Any vascular disorder that narrows or occludes the coronary arteries.
➢ Atherosclerosis is the most common cause. ➢ Risk factors
Myocardial Infarction, MI
Pathogenesis
➢ Reaction to vascular injury hypothesis ➢ lipid infiltration/insudation hypothesis
…
Atherosclerosis
Artery Wall
Atheቤተ መጻሕፍቲ ባይዱosclerosis
Chemotaxis
Obesity
➢ Can lead to high blood pressure, raised blood cholesterol levels, and diabetes
Physical Inactivity
➢ Physical activity Blood pressure HDL level
心肌梗死
➢ MI is the death of cardiac muscle resulting from ischemia .
✓ The most important form of IHD ✓ The leading cause of death
➢ A heart attack occurs when one of the arteries that supplies the heart muscle becomes blocked.
➢ Blockage may be caused by spasm of the artery or by atheriosclerosis with clot formation.
➢ The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.
➢ Angina pectoris 心绞痛
✓ Transient cardiac ischemia without cell death resulting in substernal chest pain.
Angina Pectoris
心绞痛
➢ Stabile angina 稳定性心绞痛
✓ Most common type, coronary artery ✓ atherosclerosis, increased cardiac demand
➢ Regular, moderate intensity activity brisk walking, swimming, cycling, dancing, skipping, tennis, etc.
Alcohol Consumption
➢ In small amounts it acts as a vasodilator. 1-2 drinks is good!
➢ Sex - males have a greater risk, even after women pass menopause.
➢ Family history (Genetic factors) - if family members have had CHD, there is a greater chance.
embolism Infarction
Angina pectoris, atrophy, intermittent claudication
Brain, myocardial, renal, gangrene
Complications - development
Atherosclerosis
Atrophy of the media Aneurysm
临床表现
➢ 心绞痛 ➢ 心肌梗死 • 冠➢状心动肌脉纤供维血化不足 • 心➢肌冠耗状氧动量脉剧性增猝死
➢ ……
Ischemic Heart Disease 缺血性心脏病
Myocardial ischemia
心肌缺血
➢ Local, temporary deprivation of the coronary blood supply
动脉粥样硬化 动脉中层钙化 细动脉硬化
Hyaline Hyperplastic
Etiology 病因学
➢ Exact cause is unknown. ➢ Risk Factors…
Unchangeable Risk Factors
➢ Age - the older you get, the greater the chance.
Cholesterol Crystal
Atheroma
Morphology
Development
➢ Fatty Streak（脂纹） ➢ Fibrous Plaque（纤维斑块） ➢ Atheromatous Plaque （Atheroma）
粥样斑块（粥瘤）
Fatty Streaks 脂 纹
➢ Carbon monoxide Nicotine
Diabetes Mellitus 糖尿病
➢ Uncontrolled blood sugar encourages the build up of fatty deposits within the arterial walls.
➢ A diabetic person has 2 or 3 x higher risk of atherosclerosis!
CVD is the #1 cause of death in most countries.
Heart Disease will kill 1 in 3
血 管
结 构
心 脏
血管
心瓣膜 心肌 心包
大中动脉 动脉粥样硬化 小动脉 高血压病 血管壁 动脉瘤
内膜炎瓣膜病 心肌炎 心包炎
风 湿 病
心 脏 肿 瘤
Risk Factors
Non modifiable ➢ Age ➢ Sex ➢ Family history
(Genetic)
Potentially modifiable ➢ Hyperlipidemia ➢ Hypertension ➢ Smoking ➢ Diabetes ➢ Life style, diet, and exercise
Atherosclerosis
动脉粥样硬化
Introduction
➢ Disease of the large and medium-sized arteries.
➢ Fat deposits, hardening and destruction. ➢ Major cause of IHD, MI and Stroke. ➢ Major primary cause of death in most
➢ Hypercholesterolemia – risk
高胆固醇血症
➢ Hypertriglyceridemia - less significant
高甘油三酯血症
Types of Cholesterol
➢ Chylomicrons (CM) ➢ Very low density lipoproteins (VLDL) ➢ Low density Lipoprotein (LDL) ➢ High density Lipoprotein (HDL)
more than five fold greater risk than those with blood pressures of 140/90 mmHg or lower
Cigarette Smoking
➢ Smoking aggravates the injury of endothelial cells.
HDL
➢ Tissues and cells
the liver
➢ It does not have the tendency to clog arteries.
Good cholesterol !
Hypertension
➢ A major risk factor at all ages ➢ Blood pressure exceeds 160/95mmHg
Dissecting aneurysms Rupture
Coronary Atherosclerosis
冠状动脉粥样硬化
狭窄程度
➢ I级 ➢ II级 ➢ III级 ➢ IV级
≦25% 26%-50% 51%-75% >75%
Coronary AS
Coronary Heart Disease （CHD）
countries.
artery Arteriosclerosis 动脉硬化
atheroma
arteriole
Atherosclerosis Mőnckeberg Ateriolosclerosis
Large BV Medial Sclerosis
Small BV
Intima
Medial BV
Full Thickness
➢ Unstabile angina 不稳定性心绞痛
✓ nonocclusive thrombus, occurs at rest
➢ Prinzmetal angina 变异性心绞痛
✓ coronary artery vasospasm ✓ often occurring at rest
Myocardial infarction, MI
Major Disorders of CVS
➢ Atherosclerosis ➢ Ischemic Heart Disease (IHD) ➢ Hypertension ➢ Rheumatic Heart Disease (RHD) ➢ Infective Endocarditis ➢ Valvular Heart Disease (VHD)
Nucleus
LAL
ApoA1
ABCA1
Cholesterol
HDL
Efflux
ABCG1
FC
Transcription Factors
Oxidation
FA
nCEH ATGL
HSL
TGCE
ER ACAT
Cholesterol Crystal
ADRP Perilipin
LD Proteins
Cytoplasmic LD
Changeable Risk Factors
➢ Hyperlipidemia ➢ Hypertension ➢ Cigarette Smoking ➢ Diabetes Mellitus ➢ Obesity ➢ Physical Inactivity ➢ Alcohol Intake
Hyperlipidemia 高脂血症
Monocytes Adhesion & Diapedesis
Modified LDL Intima
SRs
LDLR
Macrophage
Lumen Endothelial Cells
Cytoplasmic LD
Foam Cell
Modified LDL
CD36
SR-A Endosome
Late Endosome
Atheroma 粥瘤
Fibrous Cap Necrotic center Cholesterol Cry. Macrophages
Complications - development
Rupture Hemorrhage
Erosion, ulceration
Thrombosis
Ischemia
LDL
➢ The liver
tissues and cells
➢ A major component of the tissues and cells
➢ Atherosclerotic plaque that clogs arteries ➢ Increases risk of CHD
Bad cholesterol !
冠状动脉性心脏病 （冠状动脉粥样硬化性心脏病）
Coronary Heart Disease , CHD
➢ Any vascular disorder that narrows or occludes the coronary arteries.
➢ Atherosclerosis is the most common cause. ➢ Risk factors
Myocardial Infarction, MI
Pathogenesis
➢ Reaction to vascular injury hypothesis ➢ lipid infiltration/insudation hypothesis
…
Atherosclerosis
Artery Wall
Atheቤተ መጻሕፍቲ ባይዱosclerosis
Chemotaxis
Obesity
➢ Can lead to high blood pressure, raised blood cholesterol levels, and diabetes
Physical Inactivity
➢ Physical activity Blood pressure HDL level
心肌梗死
➢ MI is the death of cardiac muscle resulting from ischemia .
✓ The most important form of IHD ✓ The leading cause of death
➢ A heart attack occurs when one of the arteries that supplies the heart muscle becomes blocked.
➢ Blockage may be caused by spasm of the artery or by atheriosclerosis with clot formation.
➢ The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.
➢ Angina pectoris 心绞痛
✓ Transient cardiac ischemia without cell death resulting in substernal chest pain.
Angina Pectoris
心绞痛
➢ Stabile angina 稳定性心绞痛
✓ Most common type, coronary artery ✓ atherosclerosis, increased cardiac demand
➢ Regular, moderate intensity activity brisk walking, swimming, cycling, dancing, skipping, tennis, etc.
Alcohol Consumption
➢ In small amounts it acts as a vasodilator. 1-2 drinks is good!
➢ Sex - males have a greater risk, even after women pass menopause.
➢ Family history (Genetic factors) - if family members have had CHD, there is a greater chance.
embolism Infarction
Angina pectoris, atrophy, intermittent claudication
Brain, myocardial, renal, gangrene
Complications - development
Atherosclerosis
Atrophy of the media Aneurysm
临床表现
➢ 心绞痛 ➢ 心肌梗死 • 冠➢状心动肌脉纤供维血化不足 • 心➢肌冠耗状氧动量脉剧性增猝死
➢ ……
Ischemic Heart Disease 缺血性心脏病
Myocardial ischemia
心肌缺血
➢ Local, temporary deprivation of the coronary blood supply
动脉粥样硬化 动脉中层钙化 细动脉硬化
Hyaline Hyperplastic
Etiology 病因学
➢ Exact cause is unknown. ➢ Risk Factors…
Unchangeable Risk Factors
➢ Age - the older you get, the greater the chance.
Cholesterol Crystal
Atheroma
Morphology
Development
➢ Fatty Streak（脂纹） ➢ Fibrous Plaque（纤维斑块） ➢ Atheromatous Plaque （Atheroma）
粥样斑块（粥瘤）
Fatty Streaks 脂 纹
➢ Carbon monoxide Nicotine
Diabetes Mellitus 糖尿病
➢ Uncontrolled blood sugar encourages the build up of fatty deposits within the arterial walls.
➢ A diabetic person has 2 or 3 x higher risk of atherosclerosis!
CVD is the #1 cause of death in most countries.
Heart Disease will kill 1 in 3
血 管
结 构
心 脏
血管
心瓣膜 心肌 心包
大中动脉 动脉粥样硬化 小动脉 高血压病 血管壁 动脉瘤
内膜炎瓣膜病 心肌炎 心包炎
风 湿 病
心 脏 肿 瘤